Community Delivery Model
Staying Fit for the Future: Better Balance Expression of Interest Form
1. Main contact
First Name
Last Name
2. Contact Email
example@example.com
3. Facility/Club/Organisation/Group Name
4. Facility Address
5. Type of facility i.e. community hall, sports club hall, etc.
6. Website (if available)
7. Social media (if available)
8. Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
9. Does your facility have? (Please tick all appropriate options below).
Dedicated Disabled Car Parking close to the main entrance
Free parking
Public Transport links
Directions to facility on website? If so please provide link below:
10. What is the capacity of the hall/studio at your facility?
11. Does your facility have standard operating procedures in place including health safety and first aid?
Yes
No
12. Any questions you may have.
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Submit
Should be Empty: